Major Approaches to Clinical Psychology: Generalized Anxiety Disorder

PSY/480 Elements of Clinical Psychology

April 14, 2014

Compare and Contrast the Major Approaches of Clinical Psychology – Psychodynamic, Cognitive-Behavioral, Humanistic, and Family Systems in Relation to Generalized Anxiety Disorder (GAD).

Philosophical Origins

            The Psychodynamic perspective of GAD can be founded in the unconscious realms of the mind and influence the way people experience the world around him or her. Thus, “…Freud’s psychoanalytic approach, the revisionist approaches, and object relations theorists” suggest past experiences have a profound influence on the present (Plante, 2011, p. 132).

Cognitive-Behavioral Therapy (CBT) focuses on maladaptive thought patterns of GAD and the “…behaviors acquired through learning and conditioning in one’s social environment” (Plante, 2011, p. 117). Thus, anxiety behaviors are perpetuated through learning processes.

The Humanistic perspective of GAD suggests that something in the present is blocking a person’s upward growth that may extend beyond existential anxiety. Philosophically, the humanistic perspective has a phenomenological emphasis to one’s perceptions and experiences (Plante, 2011).

The Family Systems approach of GAD involves the interaction of the entire family dynamic. Although this approach has only been around since the 1950s, its main focus is on communication within the family structure.

Goals of Each Approach

The psychoanalysts’ goal is to promote growth and change, by bringing the unconscious to the conscious, helping to uncover the anxiety issue which is ultimately a defense mechanism (American Psychoanalytic Association, 2014).

The cognitive-behaviorists’ goal is to teach a patient to control his or her thoughts and actions, thus reducing or avoiding anxiety episodes.  

The humanists’ perspective is ultimately designed to promote growth toward self-actualization. In addition the humanist perspective attempts to help a person establish a harmony between his or her feelings and actions.

The goals of the family support systems approach to therapy include improved communication and a de-emphasis on the problems of a single individual over the family unit as a whole (Plante, 2011).

Techniques and Strategies Used by Each Approach

Psychoanalysis uses such techniques as lying on a couch looking away from the analyst, which enables patients to freely associate with his or her unconscious thoughts, feelings, and experiences that are, in essence, affecting his or her present thoughts and actions.

With CBT a patient may undergo “…psychoeduction, symptom management techniques, cognitive restructuring, worry exposure, and self-monitoring” (Katzman & Tsirgielis, 2011, p. 50).

Humanistic counseling is designed to help people make better choices, thus it is important for a clinician to have effective listening skills so he or she can paraphrase, reflect, summarize, and clarify what is said to him or her; helping to establish understanding of what is being said and what is not (Plante, 2011). Another helpful technique is called the empty chair, which is a common Gestalt technique, allowing a client to deal with issues in the moment.

Family support techniques involve changing the communication and relational dynamics of the family unit.

How Each Approach Affects the Treatment Strategies of GAD

Although psychoanalysis is a lengthy process, taking many months or even years to work through the “…unconscious factors that affect patterns of thought, emotion and behavior,” it can be quite liberating to a patient to understand where his or her excessive levels of anxieties began (American Psychoanalytic Association, 2014, para. 6).

CBT focuses on altering behavior (e.g., reducing tension) and cognition (e.g., redirecting negative thoughts) that produces distress (Katzman & Tsirgielis, 2011).

Humanists’ use active listening skills and then carefully reword what he or she heard so that the patient or client feels like he or she is accepted and understood, which enables growth. The empty chair method provides one with the opportunity to become aware of his or her current thoughts and feelings (Plante, 2011).   

By altering communication patterns, the family support approach encourages each person to express his or her true feelings; thus, encouraging congruent communication. Changes in relational patterns focus on appropriate levels of dependence and involvement within the family to allow autonomy and positive self-regard breaking patterns of GAD.

Evaluating the Effectiveness of Each Approach, in Relation to GAD, Based on Treatment Outcome

Generalized anxiety disorder is described as chronic, uncontrollable anxiousness over an extended period of time that affects daily functioning and sleep. Although, clearly, most treating clinicians prefer the essential components of CBT (e.g., psychoeduction, relaxation, stimulus control, desensitization, etc.) for treating GAD for its effective results, the other methods of treatment have substantial benefit too (Hoyer, van der Heiden, Portman,  & Phil, 2011). For example, family support systems are very important for treating GAD, family members who learn to support his or her loved one without perpetuating his or her symptoms by trivializing the disorder can be very helpful and important to treatment. From the humanistic perspective, mitigating negative self-talk and finding trusted outlets (e.g., friends, clergy, etc.) who are supportive can be helpful in keeping anxieties in check. As for the effectiveness of the psychodynamic style of treatment, allowing one to explore his or her interpersonal experiences and how he or she learned such patterns of avoidance and defense are insightful to the treatment process, breaking down the barriers to regression (Crits-Christoph, 2002).

References

American Psychoanalytic Association. (2014). About Psychoanalysis. Retrieved from http://www.apsa.org/ABOUT_PSYCHOANALYSIS.aspx

Crits-Christoph, P. (2002). Psychodynamic-interpersonal treatment of generalized anxiety disorder. Clinical Psychology: Science and Practice, 9(1), 81-84. Retrieved from http://www.personal.kent.edu/~dfresco/mindfulness/CPSP_crits-cristoph.pdf

Hoyer, J., van der Heiden, C., Portman, M. E., & Phil, D. (2011). Psychotherapy for generalized anxiety disorder. Psychiatric annals, 41(2), 87-94. doi:http://dx.doi.org/10.3928/00485713-20110203-07

Katzman, M. A., & Tsirgielis, D. (2011). Treatment approaches to generalized anxiety disorder. Current Medical Literature, 22(2), 37-56. Retrieved from http://search.proquest.com/docview/902876639?accountid=458

Plante, T. G. (2011). Contemporary clinical psychology (3rd ed.). Hoboken, NJ: John Wiley & Sons.